Cardiac disease in pregnancy. Part 1: congenital heart disease

Key content Heart disease is now the most common indirect cause of maternal death in the United Kingdom. Neonatal morbidity and mortality from fetal growth restriction and prematurity are markedly increased in women with heart disease. Women with congenital heart disease should ideally have a planned pregnancy managed by a multidisciplinary team which includes obstetricians, cardiologists, anaesthetists, neonatologists and midwives. Learning objectives To understand the changes to cardiovascular physiology during pregnancy. To recognise the risk factors for poor pregnancy outcome in cardiac disease. To understand the general management principles for women with cardiac disease in pregnancy. Ethical issues Should we be recommending termination of pregnancy in women with high risk cardiac lesions? How do we manage women who become pregnant against medical advice? What is the role of surrogacy in women with high risk cardiac lesions? Please cite this article as: Gelson E, Johnson M, Gatzoulis M, Uebing A. Cardiac disease in pregnancy. Part 1: congenital heart disease. The Obstetrician & Gynaecologist 2007;9:15–20.